CASE REPORT New CT signs of alveolar cell LOR Tsatsi MB ChB, FC Rad (D) SA JOOzoh BSe, MB BS, FMCR (Rad) Nigeria Department of Diagnostic Radiology Medical University of Southern Africa Case presentation An 83-year-old female patient was referred to the Medical Outpatient Department of Ga-Rankuwa Hospital in March 2002 by a general practition- er. Her complaint was chest pain and a productive cough with blood- streaked white sputum of one-month duration. Her past medical history appeared uneventful. She was a non- smoker. Her medication history revealed that she has been on antibi- otics non-stop for more than one month. On examination her respira- tion was 34/min, temperature 38°C, pulse 90 beats/min and blood pres- sure 110/80 mmHg. There was no lymphadenopathy; however, an inci- dental umbilical hernia was found. An auscultation widespread agitation was found and she coughed out white frothy sputum during the examina- tion. A provisional diagnosis of intractable pneumonia was made. Acid-fast bacilli tests were negative on three consecutive occasions. A lung function test revealed a restrictive pattern. •carcinoma Radiological investigations Chest radiography • Left lower lobe opacification (Figs 1 and 2) • Air bronchiograms in the left lower lobe (Figs 3 and 4) • No lymphadenopathy (Figs 1 - 4) • No signs of lobar collapse (Figs 1 and2) • Cardiomediastinal relationships normal. Fig. 1 Dense consolidation in the left lower zone with air bronchograms. CTscan One hundred millilitres of intra- venous iopromide was used (300 mg, Schering, Berlin, Germany) for con- trast studies of the chest. Non-con- trasted studies were also performed. Chest CT photographed on both lung 25 SA JOURNAL OF RADIOLOGY • September 2002 Fig. 2 Consolidation of the left upper and lower lobes. Fig. 3. Post-contrast axial CT showing an angiogram sign and patchy consolidation. Fig. 4 Axial CT showing squeezing and bending of air bronchograms. CASE- REPORT and mediastinal windows demon- strated the CT angiogram sign. I Attenuation of the lobe was heteroge- neous.' Multiple air bronchograms were seen" There was dilatation, stretching, sweeping, widening of the angle and crowding of bronchi .1 A pleural effusion was noted. Discussion Our patient had specific signs of bronchoalveolar consolidation which include squeezing, stretching and sweeping patent air bronchograms within the consolidated lung.' The 'crazy paving' pattern is due to thick- ening of the interlobular septae.' All these changes, due to unique lepidic growth of the tumour were also noted.' Our patient did not have satellite lesions or bulging tissues, which increase the likelihood of bron- choalveolar carcinoma (BAC). Other absent signs were pseudocavitation, air fluid level in cavities and marginal enhancement. 4,5 Although the CT angiogram sign was present it is also seen in pneumo- nia, and is therefore nonspecific." References 1. Akata S, Fukushima A, Kakizaki D, Ase K, Amino S. cr scanning of bronchioalveolar car- cinoma: specific appearances. Lung Cancer 1995; 12: 221-230. 2. Irn J, Han MC, Yu EJ, et al. Lobar bronchioalve- olar carcinoma: 'angiogram sign' on cr scans. Radiology 1990; 176: 749-753. 3. Zeuthlin N, Lasser EC, Rigler LG. Bronchographic abnormalities in alveolar cell carcinoma of the lung. Dis Chest 1954; 25: 542- 549. 4. Im J, Cho Bl, Park JH, et al. cr findings oflobar bronchioalveolar carcinoma. J Comput Assist Tomogr 1986; 10: 320-322. 5. Manning JT Jr, Spjut HJ, Tschen JA. Bronchioloalveolar carcinoma: the significance of histopathologic types. Cancer 1984; 54: 525- 534. 6. Barsky SH, Grossman DA, Ho J, Holmes EC. The multifocality of bronchioloalveolar lung carcinoma: evidence and implications of a mul- ticlonal origin. Mod Patho11994; 7: 633-640. Occult spinal dysraphism L D R Tsatsi MB ChB, FCRad D)SA Department of Diagnostic Radiology Medical University of Southern Africa B Okoli MBBS,MMed Department of Neurosurgery Medical University of Southern Africa Case presentation A 2-month-old male patient pre- sented to our outpatient's department with a diffuse back swelling. The child is the fifth in a family with no history of congenital abnormalities. The pregnancy went full term and was a normal vaginal delivery. A diffuse swelling was noted in the midline in the lumbar region. The mass was covered with normal skin, with no discolouration, hair, sinus or ulceration. It had a soft, fatty feel on palpation. There was no neurological dys- function. Plain film X-rays of the spine demonstrated spina bifida involving the whole spine with sparing of only TI2, Ll, L2 and L3 (Figs 1 and 2). The defects were more pro- nounced in the upper cervical and sacral areas. The spinous processes in the thoracic and lumbar areas were visualised though they were not fused. A CT scan reconstruction of the 26 SA JOURNAL OF RADIOLOGY • September 2002 Fig. 1 AP spinal X-ray of the cervical and thoracic spine showing the extensive spina bifida involving both regions. whole spine demonstrated the spina bifida (Figs 3 and 4). MR! findings showed a normal cord from the cervical to the sacral level.